Diagnosing carpal tunnel
Physical examination, either alone or in combination with an exploration of an individual’s self-reported symptoms, is not a good predictor of carpal tunnel syndrome (CTS) in a working population, according to this study. The researchers examined a cohort of just over 1,000 newly employed workers in several industries, using a symptom questionnaire, a structured physical examination, and nerve conduction study. The post-test probability of positive testing was less than 50% for the strategies tested.
In practice: The authors of the study suggest professionals use specific symptoms as a first-level screening tool for CTS, and nerve conduction study to confirm a diagnosis, rather than relying on physical examination.
- Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies, Descatha A et al, Occupational and Environmental Medicine 2010; 67, p133-135.
Justice and ill health
Two reports using data from the Whitehall II study point to a link between justice at work and markers of ill health. There is growing evidence showing that high levels of justice benefit workers’ health, and the first study sought to test whether it protects against the development of metabolic syndrome. Individual civil servants’ perceptions of organisational justice were tested using a questionnaire at two points between 1985 and 1990, followed by three clinical assessments for metabolic syndrome and its components between 1990 and 2004. Men who experienced a high level of justice had a lower risk of metabolic syndrome than those with low perceptions of justice, but there was little evidence of a similar association among female civil servants. A second study suggests that organisational injustice is associated with increased levels of long-term levels of inflammatory markers – for example, C-reactive protein, among male civil servants.
- Justice at work and metabolic syndrome: the Whitehall II study, Gimeno D, Occupational and Environmental Medicine, published online 9 October 2009.
- Organisational justice and markers of inflammation: the Whitehall II study, Elovainio M et al, Occupational and Environmental Medicine 2010; 67: p78-83.
Working with distressed employees can produce compassion fatigue – characterised by feelings of negative belief and isolation – among occupational health advisers (OHAs) and other caring professions, according to this study based on self-reported questionnaires. The good news for OHAs is that they, together with counsellors and police family liaison officers, are significantly more likely to demonstrate personal growth than human resources advisers, due to high levels of professional or peer supervision.
In practice: The researcher concludes that the provision of peer supervision to OHAs may be helpful in increasing reflection and ‘sense making’, leading to personal development and growth. Exercise, healthy eating and engaging in a hobby are also helpful in combating compassion fatigue.
- Compassion fatigue: experiences in occupational health, human resources, counselling and police, Tehrani N, Occupational Medicine 2010; 60(2): p133-138.
Needlestick injuries and senior surgical staff
Consultants and junior doctors are more likely to ignore local protocols covering needlestick injuries than midwives and theatre staff, and often cite the length of time it takes to follow protocols and a perceived low infection risk from patients as reasons for non-compliance. Ninety-three per cent of consultants, 67% of junior doctors and 13% of theatre staff did not comply with protocols in this study of staff in one NHS trust.
In practice: Reducing the time it takes to complete NHS needlestick injury protocols may improve compliance, the authors suggest.
- Needlestick injuries during surgical procedures: a multidisciplinary online study, Adams S et al, Occupational Medicine 2010; 60(2): p139-144.
Tinnitus and noise at work
The Health and Safety Executive (HSE) has published a useful review of the current state of knowledge on tinnitus, noise exposure and hearing loss, based on 34 relevant studies. It reports that the prevalence of tinnitus in workers exposed to noise varies hugely from study to study, from 5.9% to 87.5%, depending on factors such as the definition of tinnitus used in the research, the type of participant, and the characteristics of the noise exposure. However, the majority of papers reviewed support the idea of an association between tinnitus and noise-induced hearing loss, and one longitudinal study concludes that tinnitus may be an early indicator of a risk that noise-induced hearing loss will develop in future.
- A review of the current state of knowledge on tinnitus in relation to noise exposure and hearing loss, HSE research report no. 768, March 2010
Legal news round-up
Stonemasonry firm fined £30,000 for silica exposure
A York-based firm of stonemasons, William Anelay Ltd, has been fined £30,000 and ordered to pay £6,000 costs after two employees were left with life-shortening lung diseases. The two workers fell ill after being exposed to uncontrolled levels of respirable crystalline silica between 1994 and 2008, caused by dry stone carving without extraction ventilation or use of protective equipment. The firm pleaded guilty to breaching Section 2(1) of the Health and Safety at Work etc Act 1974, which places a duty on every employer to ensure, so far as reasonably practicable, the health, safety and welfare at work of all employees.
In practice: Health and Safety Executive inspector Julian Franklin reminds employers and practitioners of the need to take correct steps if working with silica-based materials such as limestone, cement, mortar and sandstone.
£110,000 stress payout for university employee
A former employee of Staffordshire University has received £110,000 in compensation after giving up work due to stress. Mark Bannister worked as a programme manager at the university, organising courses for growing numbers of international students. His workload increased further still when one colleague committed suicide and a second went on long-term sick leave, meaning his team of four people were doing the work of six, and he was working 65 hours a week. Despite his medical history of anxiety and depression, and the fact that he complained to the employer about an excessive workload, the employer did not take any action to deal with his situation. Eventually, Bannister was signed off sick in September 2007, although he returned to work briefly, before giving up work due to stress-related illness.
In practice: Warinder Juss from solicitors Thompsons points out that, despite Bannister’s history and the fact that he brought his concerns to the employer, nothing was done to investigate his complaints, or to ensure he was coping with the workload. “Stress cases are difficult to prove, but here Mr Bannister was ignored and felt he had no choice but to work excessive hours, and the damage to his health followed.”